Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France.
Multidisciplinary Oncology and Therapeutic Innovations Department, Aix Marseille Univ, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Marseille, France.
Expert Rev Anticancer Ther. 2022 Aug;22(8):815-822. doi: 10.1080/14737140.2022.2102482. Epub 2022 Jul 25.
Unresectable pleural mesothelioma is a poor prognosis disease. Improvement in overall survival (OS) has been shown with PEMETREXED combined with CISPLATIN. BEVACIZUMAB combined with chemotherapy is associated with an improvement in OS, compared to chemotherapy alone, but is not supported by health insurance everywhere.
Immune Checkpoint Inhibition (ICI) monotherapy seemed to be promising but is controversial. ICI combination showed significant results. NIVOLUMAB, an anti-Programmed-Death-receptor 1, associated with IPILIMUMAB, an anti-Cytotoxic-T-Lymphocyte-Associated-protein 4, was evaluated in two phase II trials and a phase III trial, recently published. This combination led to a significant benefit in survival in first line compared to chemotherapy (OS 18.1 months (95%CI (16.8-21.4)) vs 14.1 (95%CI (12.4-16.2) HR 0.74 (95%CI 0.6-0.91) p = 0.002).
These results represent a big step in unresectable pleural mesothelioma. The benefit in non-epithelioid subtype is impressive (OS 18.1 months (95%CI 12.2-22.8) vs 8.8 months 95%CI (7.4-10.2) HR 0.46 (95%CI (0.31-0.68))). Benefit in epithelioid subtype (OS 18.7 months 95%CI (16.9-22) vs 16.5 95%CI (14.9-20.5) HR 0.86 95%CI (0.69-1.08)) is similar to the benefit of the combination of BEVACIZUMAB and chemotherapy. Identification of predictive biomarkers is needed to identify patients who are most likely to benefit from each therapeutic strategy.
无法切除的胸膜间皮瘤预后较差。培美曲塞联合顺铂已显示出总生存期（OS）的改善。贝伐珠单抗联合化疗与单独化疗相比，OS 改善，但并非所有地方的医疗保险都支持。
免疫检查点抑制（ICI）单药治疗似乎很有希望，但存在争议。ICI 联合治疗显示出显著的效果。抗程序性死亡受体 1 的纳武单抗（NIVOLUMAB）与抗细胞毒性 T 淋巴细胞相关蛋白 4 的伊匹单抗（IPILIMUMAB）联合，在两项 II 期试验和最近发表的一项 III 期试验中进行了评估。与化疗相比，这种联合治疗在一线治疗中显著提高了生存率（OS 18.1 个月（95%CI（16.8-21.4））与 14.1 个月（95%CI（12.4-16.2）），HR 0.74（95%CI 0.6-0.91），p=0.002）。
这些结果代表了无法切除的胸膜间皮瘤的一大进步。非上皮样亚型的获益令人印象深刻（OS 18.1 个月（95%CI 12.2-22.8）与 8.8 个月 95%CI（7.4-10.2），HR 0.46（95%CI（0.31-0.68）））。上皮样亚型（OS 18.7 个月 95%CI（16.9-22）与 16.5 个月 95%CI（14.9-20.5），HR 0.86 95%CI（0.69-1.08））的获益与贝伐珠单抗联合化疗的获益相似。需要确定预测生物标志物，以确定最有可能从每种治疗策略中获益的患者。
